IMPORTANT DISCLAIMER: This article is informational and not medical advice. Gambling disorder requires assessment by qualified professionals. If you are experiencing thoughts of self-harm related to gambling losses, contact the 988 Suicide and Crisis Lifeline (call or text 988) immediately.
Gambling disorder holds a unique position in psychiatric classification: it is the only behavioral addiction included in the DSM-5 — placed alongside substance use disorders, not impulse control disorders, because of the striking similarities between gambling disorder and substance addiction in neurobiology, clinical presentation, and treatment response. This classification reflects decades of research demonstrating that compulsive gambling engages the same reward circuits, produces similar tolerance and withdrawal-like phenomena, and responds to similar therapeutic approaches as substance use disorders.
For the millions of Americans affected by problem gambling — numbers that have grown substantially with the explosion of legal sports betting and online gambling platforms — understanding what gambling disorder is, when it requires treatment, and what effective treatment looks like is clinically important.
DSM-5 GAMBLING DISORDER CRITERIA
The DSM-5 defines gambling disorder by the presence of four or more of the following nine criteria within a 12-month period, causing significant distress or impairment:
- Needs to gamble with increasing amounts of money to achieve the desired excitement (tolerance).
- Is restless or irritable when attempting to cut down or stop gambling (withdrawal-like phenomena).
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
- Is often preoccupied with gambling (reliving past gambling experiences, planning next gambling opportunity, thinking about ways to get money to gamble).
- Often gambles when feeling distressed — helpless, guilty, anxious, or depressed.
- After losing money gambling, often returns another day to get even — “chasing losses.”
- Lies to conceal the extent of gambling involvement.
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
- Relies on others to provide money to relieve desperate financial situations caused by gambling.
Severity is specified by the number of criteria met: 4-5 criteria = mild; 6-7 = moderate; 8-9 = severe.
THE NEUROSCIENCE OF GAMBLING
Gambling disorder’s classification alongside substance addictions reflects genuine neurobiological similarities. Understanding these helps explain why gambling disorder has the clinical features it does.
Dopamine and the near-miss effect:
Gambling activates the dopamine reward system in ways that go beyond simple winning and losing. Neuroimaging studies show that near-misses — outcomes that almost succeed, like two out of three symbols on a slot machine — activate the reward circuit in ways similar to actual wins, even though a near-miss is objectively a loss. This neurological quirk is extensively exploited in gambling machine design and drives continued play despite losses.
Variable ratio reinforcement:
Gambling operates on a variable ratio reinforcement schedule — unpredictable, intermittent reward — which produces the most persistent and extinction-resistant behavior of any reinforcement pattern. This is the same mechanism that makes slot machines so difficult to stop playing; the brain never fully habituates to the uncertainty of when the next reward will come.
Loss chasing:
The phenomenon of “chasing losses” — returning to gamble to “get even” — has a specific neurobiological basis in disrupted prefrontal cortical control over the urge to recover losses. The impaired impulse control characteristic of gambling disorder allows loss chasing to dominate over rational recognition that continued gambling is statistically unlikely to produce recovery.
Tolerance and withdrawal:
Over time, gamblers often report needing larger bets to produce the same excitement (tolerance) and experiencing restlessness, irritability, and dysphoria when not gambling (withdrawal-like phenomena). These mirror substance tolerance and withdrawal and further support the addiction classification.
TREATMENT APPROACH
Effective treatment for gambling disorder parallels substance use treatment in many ways, reflecting the shared neurobiological underpinnings.
Cognitive Behavioral Therapy (CBT):
CBT is the most evidence-supported psychological treatment for gambling disorder. Key CBT components for gambling include:
- Identifying and challenging cognitive distortions about gambling. People with gambling disorder commonly hold specific irrational beliefs: the gambler’s fallacy (“after this many losses, I’m due for a win”), illusions of control (“I have a system”), and magical thinking about winning. CBT identifies and directly challenges these distortions.
- Functional analysis of gambling behavior. Understanding what triggers gambling episodes — emotional states, environmental cues, specific times of day — and developing alternative responses.
- Relapse prevention. Identifying high-risk situations and planning specific, practiced responses.
Motivational Interviewing:
For people with ambivalence about stopping gambling (very common), motivational interviewing helps resolve ambivalence toward change through empathic, non-confrontational exploration of the costs and benefits.
Financial counseling:
Given the typically significant financial consequences of gambling disorder, financial counseling — debt management, budget development, understanding the financial reality — is an important component of comprehensive treatment. All medication decisions, including those related to any pharmacological approaches, are made by qualified physicians.
Peer support — Gamblers Anonymous:
Gamblers Anonymous (GA) is the 12-step program specifically for gambling disorder, structured similarly to AA. GA provides peer community, accountability, and the specific lived-experience support of others who have navigated gambling disorder. Research on GA shows benefits similar to 12-step for substance disorders.
CO-OCCURRING WITH SUBSTANCE USE
Gambling disorder and substance use disorders co-occur at substantially elevated rates — approximately 20-30% of people with gambling disorder also have an alcohol use disorder, and elevated rates of other substance use disorders are also documented.
Several mechanisms connect them:
Shared neurobiological vulnerability.
The same reward-system characteristics that create vulnerability to gambling addiction also create vulnerability to substance addiction. People with one may be neurobiologically vulnerable to the other.
Environmental co-occurrence.
Alcohol is often available and consumed in gambling environments (casinos, poker games), and alcohol’s disinhibiting effects can increase gambling behavior in people vulnerable to it.
Emotional regulation function.
Both gambling and substance use can serve as emotional regulation strategies — managing stress, anxiety, depression, or boredom through behavioral or substance-induced means.
When both gambling disorder and substance use disorder are present, integrated dual diagnosis treatment addressing both simultaneously is the appropriate approach — the same principle that applies to any co-occurring conditions. Treating only one leaves the other maintaining.
At Oceánica, co-occurring gambling disorder and substance use is assessed and addressed within the dual diagnosis treatment framework.
RECOVERY SUPPORT
Recovery from gambling disorder, like recovery from substance use, benefits from sustained peer support, ongoing therapy, and specific environmental modifications.
Environmental modifications:
- Self-exclusion programs. Most states with legal gambling have self-exclusion programs that ban a person from entering casinos and sometimes from online gambling platforms. Proactively using self-exclusion removes access — one of the most concrete harm-reduction measures available.
- Removing apps and access. Deleting gambling apps, blocking gambling websites, and removing access to gambling funds (having someone else hold bank cards) reduces availability.
- Managing financial access. Many people in gambling recovery work with a trusted person who manages finances during early recovery, reducing the ability to access gambling funds impulsively.
Peer support:
Gamblers Anonymous is the primary peer support resource. National Council on Problem Gambling’s helpline (1-800-522-4700) provides referrals and support. Some areas have Gam-Anon — support for families of people with gambling disorder, similar to Al-Anon.
Ongoing therapy:
Gambling disorder, like substance use disorder, is a chronic condition that benefits from sustained therapeutic support — particularly for the management of the cognitive distortions and emotional regulation deficits that drive gambling behavior.
FREQUENTLY ASKED QUESTIONS
Is gambling disorder a real addiction?
Yes. Gambling disorder is classified in the DSM-5 alongside substance use disorders (not in the impulse control section) because of its shared neurobiological mechanisms, clinical features (tolerance, withdrawal-like phenomena, loss of control, chasing), and treatment response. It is the only behavioral addiction in the DSM-5.
What is “chasing losses” and why is it so hard to stop?
Chasing losses — returning to gamble to recover previous losses — reflects impaired prefrontal control over the urge to recover, combined with irrational beliefs about probability. The neurobiological disruption of gambling disorder makes the rational recognition that chasing typically produces more losses very difficult to act on.
What treatment works best for gambling disorder?
Cognitive Behavioral Therapy has the strongest evidence base, particularly for addressing the cognitive distortions that drive gambling. Motivational interviewing helps with ambivalence. Gamblers Anonymous provides peer support. Financial counseling addresses the often severe financial consequences. For co-occurring substance use, integrated dual diagnosis treatment is appropriate.
Does Oceánica treat gambling disorder?
Oceánica treats gambling disorder when it co-occurs with substance use disorder, within the integrated dual diagnosis treatment framework. For gambling disorder without substance use disorder, Oceánica’s team can discuss the assessment and refer to appropriate specialized resources.
Recommended Reading
- Sports Betting Addiction: America’s New Epidemic
- Dual Diagnosis Rehab in Mexico
- Behavioral Addictions Overview
- Services and Programs at Oceánica
EXTERNAL REFERENCE LINKS
- National Council on Problem Gambling (Helpline: 1-800-522-4700)
- Gamblers Anonymous
- SAMHSA National Helpline
- Oceánica Conecta
Oceánica is a CARF-accredited residential treatment center in Mazatlán, Mexico. If you are having thoughts of self-harm related to gambling losses, call or text 988 immediately. This article is informational and not medical advice. Call (213) 527-3377 or visit oceanica-usa.com.
